As in most countries in Africa, well qualified medical and nursing staff often choose to work in the cities, assuming they do not join the brain drain and emigrate to greener pastures overseas. Rural areas are seriously neglected and one doctor may be trying to care for many thousands of patients alone (as compared with one doctor available for 250-400 people in the West). In Uganda the District of Mukona typifies this problem. It covers an area of 1875 square kilometres with a population of over 600,000 growing at 2.7% per annum. This figure can expand rapidly during the fishing seasons from islands on Lake Victoria. Much of this population live in villages with individuals surviving on less than one dollar per day. The governmental hospitals and clinics are poorly equipped and lacking the most basic medicines, leading to low staff morale. Serious cases may need to travel 50-100 kilometres over poor roads to get to reasonable hospitals in Kampala or Naggalama.

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The lack of resources leaves neglected many cases of malaria, HIV/AIDS, child, maternal and pregnancy problems. A socio-economic profile in 2008 indicated that 40% of patients admitted to hospital or seen at clinics had malaria. It is the highest cause of morbidity and mortality of children under five years of age and of pregnant women. Mukono District was one the three worst districts in Uganda for HIV/AIDS prevalence rates. Whilst road improvements have opened up the district and hastened transport, the negative impact has been a big increase in serious road accidents and physical trauma needing rapid critical care and life-saving surgery not locally available.

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In 2013, Kisoga born Mr Mukalazi Henry Garvin, who is Head of the Radiology Department in St Francis Naggalama Hospital, decided to open a diagnostic, medical and imaging centre in his home village. He opened the Herona Medical and Imaging Centre (HMIC) as a private not-for-profit enterprise, fully registered and licensed by the Ministry of Health, in a small rented building. Garvin’s mission was to provide affordable health services to the community, mainly Kisoga and Ntenjeru Sub County but six other sub-counties and Koome Island too.

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Ever since he has, at great expense to himself, provided a service whose objectives were to:

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• provide medical and imaging such as ultrasound scans unavailable in the government clinics in the area

• reduce the incidence of infant and maternal morbidity and mortality by offering proper ante-natal, maternity and post-natal care

• offer imaging check-ups and comprehensive HIV care, thus reducing co-morbidities and the high incidence of deaths from AIDS

• provide basic dental care such as extractions

• offer a vaccination service for children

• carry out minor operations

• run a basic diagnostic laboratory

 

Many outpatients have come through the doors, many receiving anti-retroviral therapy (ART) and women in the prevention of HIV mother-to-child transmission (PMTCT) project. Many women have been admitted for childbirth, and most recently many patients have arrived as emergencies following road accidents.

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Despite these heroic efforts, it has become clear that this facility is totally inadequate for the rapidly increasing demands made on it.

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Particular problems now arising make a move to far bigger premises imperative.  These comprise:

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• a lack of private surgical and emergency rooms; many patients are so poor financially that they cannot afford to pay any fees so it is difficult to pay the high rent demanded by the landlord

• there is poor transportation for serious cases to be driven to decent hospitals, in Kampala for example

• the widening of the main road outside the clinic means that the building can be demolished at any time

 

Garvin identified these problems soon after establishing the HMIC and started to plan an alternative strategy in early 2014. Essentially this was an expansion and upgrade of the HMIC. He proposed seeking support for construction and infrastructure of a rural hospital in Kisoga to be badged as Herona Hospital.